Communicating Nutrition at the Point of Purchase

The average American consumer spends 44 minutes on a typical grocery trip (Hamrick et al. 2011). This includes the time to find all the items they need, compare brands, price, flavors, and nutrition, consider any in-store specials, check out, pay, and pack their groceries. Anything that speeds up these activities is beneficial to the consumer.

Retail grocery stores understand this point, with improvement of store navigation a priority across the industry. Whether it’s pointing the shopper to the right area of the store, placing high interest items in convenient locations, or cross-merchandising foods commonly eaten together (e.g., bananas in the cereal section of the store), retailers are committed to helping shoppers navigate the store and find the products they need.

Over the past five years, retailers have begun to leverage health navigation with the launch of nutrition guidance systems at the point of purchase. Whether in the form of shelf-edge communication or on-package messaging, shoppers today have various tools to help them quickly assess the nutritional value of foods in grocery store aisles.

Nutrition Guidance Programs
Various types of nutrition guidance programs are currently being used in the marketplace, including fact-based, threshold, and nutrition ranking systems.

• Fact-Based Programs: Grounded in Food and Drug Administration (FDA) nutrient content claims, these programs highlight fact-based statements indicating the product is low fat, high in fiber, a good source of calcium, or heart healthy. These systems also feature “lifestyle” claims such as gluten free (not currently regulated) or organic. In general, products tagged in these programs meet the FDA’s disclosure levels before a callout can be made.

Publix’s Nutrition Facts and Safeway’s Simple Nutrition™ are examples of fact-based systems implemented at the grocery store shelf. Twenty-two benefit messages are included in Simple Nutrition, including lifestyle messages like organic and natural and nutrient or ingredient-specific callouts on fat amount and type, vitamins, minerals, and calories. Tag signs in the grocery store aisles are based on relevancy in the category. For example, fiber and whole grains are important attributes of grain products, and would be highlighted on cereal products. Publix’s Nutrition Facts program is very similar in execution.

Another retailer fact-based program is Wegmans Wellness Keys. While this program features similar callouts to other attribute programs, Wegmans leverages their Wellness Keys across recipes as well, providing consumers with a consistent message related to nutrition.

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Facts Up Front, managed by the Grocery Manufacturers Association (GMA) and the Food Marketing Institute (FMI), is a fact-based program implemented directly on product packages. In this system, the numerical data for key nutrients—calories, saturated fat, sodium, sugars, and up to two positive nutrients—are displayed on the front of the product package. The nutrients included are believed to be the most important for consumers when making purchase decisions. The effort is a voluntary, industry-lead initiative, and GMA and FMI member companies have pledged $50 million for consumer education. A primary element of the consumer education campaign is a website, which is targeted to launch this fall. Products that are not packaged or labeled, such as fresh fruits and vegetables and single-ingredient meats, are not included in the program, which is considered a drawback of the system.

The American Heart Association’s Heart-Check program is based on FDA-approved health claims related to heart-health, including the role of saturated and trans fat, cholesterol, whole grains, nuts, and omega-3 fatty acids. The program is implemented on both product packages and shelf edge. Plans are in place to update the sodium criteria, limit added sugars, and implement fiber guidelines in whole grain products by 2014.

• Threshold Program: In these systems, a product must meet certain levels or limits for a variety of nutrients in order to gain the “stamp of approval.” In Walmart’s Great for You program, for example, single-ingredient foods that are a fruit or vegetable, a 100% whole grain product, an unflavored low-fat or nonfat milk or yogurt, a protein food that meets the definition of lean, or a fat/oil/nut/seed with no more than 15% of calories from saturated fat can carry the icon. For multi-ingredient foods that contain one of these components, there are specific criteria related to limits for total, saturated and trans fat, sodium, and sugar. Similar to Facts Up Front, Great for You is implemented on product packages (currently on Walmart private label products).

Another example of a threshold program is Ahold’s Healthy Ideas™, a shelf-edge communication program. All products tagged meet the FDA’s definition of “healthy,” which includes limits on total and saturated fat, cholesterol, sodium, and sugar. Foods must also include at least 10% of the Daily Value for protein, fiber, vitamin A, vitamin C, calcium, or iron, and contain no trans fat.

• Ranking Programs: Programs such as NuVal® and Whole Food’s Aggregated Nutrition Density Index (ANDI) use algorithms to evaluate the nutrient density of foods. These mathematical equations take into account a variety of nutrients which have a positive and/or negative impact on health. NuVal factors in both macro and micronutrients, the relationship of nutrients to disease risk, and the quality of the macronutrients. For example, omega-3 fatty acids would positively impact scores in light of their positive effect on health, while saturated fat would negatively impact scores. Alternatively, ANDI is focused on vitamins, minerals, and antioxidants.

In both systems, the shopper is presented with a numerical ranking (i.e., 1 to 100 with NuVal and 1 to 1,000 with ANDI), whereby a higher score indicates a more nutritious product. ANDI has come under scrutiny by health professionals in light of some of the scores. While kale scores a perfect 1,000, blueberries score a 130, an orange 109, and lentils 104. The question is whether this is an appropriate message for consumers when so few people in this country consume the recommended amount of fruits and vegetables.

Guiding Stars® at Hannaford Supermarkets and Food Lion is a hybrid of a threshold and ranking program. Foods must first meet specific threshold criteria, and then an algorithm is used to rate the food’s nutrition quality, communicated in 1, 2, or 3 stars, with 3 indicating the best nutritional value. Vitamins, minerals, fiber, and whole grain drive a score up, while saturated and trans fat, cholesterol, added sugar, and added sodium will drive a score down. Foods which do not meet the threshold criteria receive no stars. In addition to retailers, Guiding Stars is being used in cafeteria settings.

Some retailers have started using multiple types of these programs in combination in an effort to meet the needs of the wellness guest looking for overall information as well as the shopper interested in specific nutrients or ingredients as part of managing a health condition.

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Regulatory Agency Activity
In 2010, the U.S. Congress directed the Centers for Disease Control and Prevention to undertake a study with the Institute of Medicine (IOM) on front-of-package systems and nutrition symbols. The project was completed in two phases. In Phase I, the IOM committee assessed the various types of systems being used in the industry—nutrient specific, summary indicator, and food group information systems. The committee concluded that more research was needed to understand how consumers use the various systems and which are most likely to change consumer behavior and health. The committee report also indicated those nutrients most important to feature on the front of package are calories, saturated and trans fat, and sodium as well as serving size in common household measures (IOM, 2010).

Phase II of the committee’s work assessed which systems could most impact public health and offered recommendations on the most effective way to develop and implement a standardized front-of-package nutrition labeling system. The committee recommended the FDA and U.S. Dept. of Agriculture (USDA) develop, test, and implement a universal standardized system that would replace all existing systems (IOM, 2012). The model suggested by the committee was based on the energy efficiency rating system, and would include calories and a common household measure, and one to three points for saturated and trans fat, sodium, and added sugar. A key constraint of this recommendation is that added sugars are not currently included in the Nutrition Facts Panel (NFP), and in order for this information to be included on the front of package, a change to the NFP would need to happen first.

A key point of the IOM’s recommendation was for a universal, standardized system. If looked at as solely a front-of-package implementation, a universal system is important to ensure consumers have the same information to compare one product to another sitting side-by-side on the grocery shelf. The explosion in growth over the past five years, however, has been in retail point-of-purchase nutrition guidance systems. A consumer who lives in California rarely grocery shops in Texas or Maine, and to this end, he/she needs a reliable, easy-to-use system that guides them to healthier choices only in the stores they routinely shop, raising the question of whether a universal system truly is needed.

The regulatory agencies have not provided direct opinion on the various systems currently in the marketplace. The attributes in fact-based programs are typically derived directly from FDA-approved claims. An exception is gluten-free claims, commonly used as a lifestyle attribute in these programs, but which has not been defined by the regulatory agencies. Some of the threshold programs are using limits for sugar, also not defined by the regulatory agencies. FDA, however, was regularly consulted throughout the development of the Facts Up Front program.

In May 2012, the National Consumers League (NCL) sent a letter to the FDA requesting they warn retailers against using proprietary nutrition ranking systems such as NuVal, stating they are inconsistent with FDA guidance and enforcement correspondence, recommendations from the IOM, and federal nutrition programs. Key points raised by the NCL were belief that the algorithm used in the NuVal System is propriety and nontransparent, that the system has the potential to mislead consumers, and that the guidance is inconsistent with the 2010 Dietary Guidelines for Americans and the school lunch program. As of press time, the FDA has not responded to the NCL letter.

How Effective Are They? 
With estimates suggesting a typical grocery store carries more than 40,000 items, the question is whether these programs are effective at guiding consumers to more nutritious foods and driving behavior change to healthier eating habits. A study of Guiding Stars found the guidance system led to cereal purchases with more stars (e.g., less added sugar and more fiber) immediately after implementation in the retail chain as well as one and two years later (Sutherland et al. 2010). In 2006, 24.50% of cereal purchased earned at least a star, which increased to 24.98% and 25.89% at one and two years post-implementation. The study also found a reduction in the purchase of products which did not receive any stars. A study conducted by the Harvard School of Public Health on the NuVal System found that eating foods with a higher score was associated with a lower risk of cardiovascular disease, diabetes, and all-cause mortality (Chiuve et al. 2011).

Presented at the 2012 IFT Annual Meeting in June, the American Heart Association has completed an in-store purchase impact analysis with their Heart-Check program. In the study, food products which were tagged on package and on shelf had a 5% sales lift compared to controls (Milne, 2012). In a study comparing a consumer’s ability to choose the more nutritious food using Facts Up Front or the Traffic Light system (which uses red, yellow, and green colors to indicate low, medium, and high levels of key nutrients, respectively), the color-coded system outperformed Facts Up Front (Roberto et al. 2012).

As part of the development process for Facts Up Front, GMA provided grant funding to the International Food Information Council to conduct consumer research. The results of an online survey revealed that information provided on the front of package increased consumers’ understanding of key nutrients and that including positive nutrients did not detract from the importance of calories or negative nutrients (IFIC 2011). The study also found that any information included on the front of package was beneficial to most study participants in identifying the product with higher nutrition quality.

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Health & Wellness at Retail
Historically, messaging related to the nutritional quality of foods has resided with the manufacturer. Over the past several years, however, retailers have begun to take an active role in leveraging health and wellness as a shopper service and differentiator from their competition. For a variety of reasons, retailers are ideally suited to provide nutrition education and health promotion to consumers. Grocers can be brand neutral, provide a consistent message across the store, and have frequent contact with the consumer.

A key factor for retailers in determining their health and wellness offerings is how to meet the needs of both the “wellness” shopper as well as the consumer looking for specific nutrient information to manage a health condition. The style of nutrition guidance system the retailer offers may be an indication of their approach. Those targeting the pharmacy shopper with a disease may choose to implement a fact-based system which provides information specific to key nutrients like saturated fat, fiber, and sodium. Retailers more geared towards the wellness guest may choose ranking systems.

Many retailers look to point-of-purchase systems as the cornerstone of their health and wellness strategy, building out offerings around these programs. Other services offered include store tours, one-on-one consultation with a registered dietitian, weight management programs, diabetes education classes, and support groups. Today, more than 400 registered dietitians are employed by retailers, showcasing the commitment to provide credible nutrition guidance to shoppers.

More and more, pharmacists are taking an active role in health and wellness programs in the retail space. The pharmacy customer is very valuable to the retailer, and services are offered to attract and retain this shopper. At Wegmans and Price Chopper, for example, you’ll see cross merchandising of better-for-you foods in the pharmacy. Some pharmacists at Safeway and Kroger are trained as diabetes educators, offering classes and advice to this shopper. Both pharmacists and dietitians are being leveraged in employee health promotion campaigns, reaching a large consumer base across the retail industry.

Implications for Product Development
As retailers establish themselves as key partners in major public health objectives, it’s clear that point-of-purchase nutrition guidance, whether front-of-package or shelf edge, is here to stay. Product development professionals and food companies can utilize these systems to their benefit.

Benchmarking products against the competition is commonplace in the food industry, and these systems provide models to use when benchmarking on nutrition. Systems like ANDI and NuVal provide an opportunity to compare competitive products based on their nutrition score. Having a higher score or more compelling attribute callouts than the competition gives the consumer one more reason to buy. As manufacturers develop or market new products to retailers, it is important to consider the grocer’s system of choice and how to effectively position the new product within this system.

One of the greatest challenges for all shelf-edge programs is ensuring the products’ scores or attributes are based on the manufacturer’s current formulation and label. With the frequent rate of change on food products as well as regional formulations and “in-and-out” promotions, it can be difficult to keep information current. Manufacturers have the opportunity to partner with these programs to ensure product data is accurate and up to date.

What’s Next?
Historically, grocery retailers have been most effective at implementing promotional type programs and events. Large displays of Super Bowl party foods, ordering options for ready-made Thanksgiving meals, and back-to-school promotions are examples. With health and wellness, retailers are proving they can maintain a long-term, ongoing commitment to being a solution provider to their shopper.

Annette Maggi, M.S., R.D., L.D., F.A.D.A., a member of IFT, is President, Annette Maggi & Associates, Inc., 5941 Burke Trail, Inver Grove Heights, MN 55076 ([email protected]).

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